Depression Part 2: The Road Back to Normal

Continuing on from last week’s post, I’m here to bum you out, go on about how strange brains are, and hopefully offer some insight on how to start solving the divisive disease that is depression. The same caveats apply as before.

So, I find the pattern of punctuated equilibrium cropping up again and again. In brief, it is a way of thinking about the speed at which things change. Specifically, some things will spend a long time in a stable state, not changing much at all, and then suddenly leap forward in a giant generational shift. It can be a little bit of deviation creating a huge watershed, or a little energy added into the system bumping things out of their stable rut. You can observe the phenomena in everything from evolutionary biology to organic pathfinding.

It might help to think of this in terms of a game. In game theory, systems can stay stable for long periods of time before taking a wild shift to a different stable mode. In the classic game Hawks vs Doves [mildly technical video] you have two groups: the hawks will never back down from a fight even if it costs them a lot, and the doves will always back down but will split winnings evenly. If you start with two even populations of doves and hawks, you have random fights between everybody, and you kick out the biggest losers, you will eventually have a fairly stable ratio between the two groups.

Nobel laureate John Forbes Nash at his country estate

Given an infinite amount of time, that ratio will be the Nash Equilibrium, or the ideal ratio between all the possible strategies of that game. It’s simple if you imagine you’re trying to maximize your score on an arcade game. You get a long series of encounters where you either get to pick hawk or dove before the encounter. Your opponent has the same setup. The ratio between the times you pick dove and the times you pick hawk to get the highest score will be the Nash Equilibrium. Essentially you’re trying to play your best strategy where you know all the possible moves, both yours and your opponent’s, like in a game of chess.

What am I getting at with all this game theory stuff? I said things would reach their Nash Equilibrium given an infinite amount of time. But, in finite time, you’ll notice stable modes in the hawk and dove populations that are not the Nash Equilibrium. These are called local equilibria. You can also influence jumps between these states by altering the payouts and punishments of the game.

I see depression as being a stable, self-perpetuating equilibrium that, once entered, takes substantial energy to escape. Do you recall the long term potentiation stuff I was talking about in the last installment? I believe that once you lay down a substantial set of potentiated pathways that encourage the production of stress hormones, you fall into the trough of long term depression.

Things stop feeling good. Neurobiology superstar Robert Sapolsy says the main symptom of depression is “the inability to appreciate sunsets”. The official term for this is anhedonia, or the inability to seek or feel pleasure. Not feeling pleasure causes people to not seek pleasure, causing them to not feel pleasure. This is amplified by the inability to get up and do anything at all, or phychomotor retardation, that is characteristic of a major depressive episode. It’s a sad irony that people on the upswing from a major depression are more likely to commit suicide than those at its nadir for the simple expedient that it’s just too much work to go about finding a knife, running a bath, and slitting your wrists.

Robert Sapolsky shown here just after someone rolled a 5 or an 8.

There are many contributing factors that influence your likelihood of experiencing clinical depression. The death of a parent at an early age, having a sibling with severe depression (if your identical twin is depressed, you have a 50% chance of experiencing the same condition), the overproduction of monoamine oxidase, can all severely increase the chances of depression. [As a side note, I’d like to remark that a lot of the twin/adoption studies you read, especially the ones involving twins separated at birth, come from research gathered from the Scandinavian peninsula. The explanation I’ve heard for this is that the Vikings held a lot of stock by inheritance regardless of whether it went to their natural or adopted progeny. Apparently there have been extensive records of adoptions, christenings, name changes, and health data stretching back a few hundred years. It seems that, if you’re looking to isolate genetic factors from environmental factors by looking at two people who share a genome but not a house (eg twins separated at birth), you start by phoning up an academic in the +011-46 area code.]

Since the factors are so varied in nature (biological, genetic, conceptual) I’ve come to think that depression is a kind of parasitic meme. It’s an alternate mode on which the standard workaday mechanisms in your mind can run.

So, how do you get rid of a deleterious viral meme? The way I see it, you’ve got to bust up your rut. The effective therapies seem to retread the brain with new pathways that don’t egg on the existing tag team of stress-related chemicals sparking stress-like trauma. One of the most effective treatments for severe long term depression is a brand of shock therapy, which seems to change up the pattern of potentiated neurons in specific areas of the brain. It does have side effects, so it’s usually a method of last resort.

In the meantime, exercise, change of diet, and restructuring your life to include more small bits of happy seem to be effective therapies for avoiding depression or steering your way out of a minor depressive episode. For me, it’s been about cultivating a certain state of mind. I find that if I can cut off the thoughts that lead to depressive cycles, critically analyze my feelings, and plot a course of action that leads me to a better state of being with discrete, actionable goals, I can actually pull myself into a stable happy state.

This bear must be stressed. Why else would he be covered in cocaine?

The way it seems to work is that there are coping mechanisms for the big things in life. One can cope with a big loss because there’s a framework on which to hang the death of a loved one, or losing your house in a fire, or getting your car stolen. There’s a clear way for people to give sympathy, to help, and to grieve. It can be the little things that are more insidious. Often times state of mind is about the little things: getting passed up for a raise, stubbing your toe, having your dog go missing, all stacked together and adding up to a feeling about the state of the world. Experiments with rats, randomly shocking them over long periods of time, show that once you pass a certain threshold of arbitrary bad shit happening, it becomes the expectation that arbitrary bad shit is the default state of the world. Rats exposed to shocks for as little as five minutes showed heightened stress and anticipation of getting shocked again nearly a month later. It also makes them use cocaine, which explains some things.

So, it comes down to creating enough good experiences, enough coping mechanisms, and and a support network of people to catch you to counteract the random knocks towards the slope of depression that the world offers. Remember the lesson of Ilya Zhitomirskiy: it’s your job as a friend of someone who has suffered from depression to be their support network, to be understanding, and to overcome the social pressure to not talk about the disease. It can’t, necessarily, be conquered but it can be remediated, and it’s up to you to bust up that rut.